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NPI Code Detail

MEDICARE: DR. TYLER DYKEMA PHARM.D

MEDICARE: DR. TYLER DYKEMA PHARM.D
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist14745OK

General Provider Information

NPI Number : 1538442579
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TYLER DYKEMA PHARM.D
Provider Business Mailing Address
First Line : 2345 N CLASSEN BLVD
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73106-5804
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2345 N CLASSEN BLVD
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73106-5804
Country : US
Telephone Number : 405-521-0924
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2011
Last Update Date : 09/26/2011

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